Gastroesophageal Reflux (GER)

GER is a condition where the contents of the stomach come back up into the esophagus (food pipe). This occurs when the circular muscle at the top of the stomach (known as the lower esophageal sphincter) relaxes and creates an opening. The lower esophageal sphincter is located at the junction of the esophagus and the stomach. The sphincter relaxes when a child eats to allow food in and when a child needs to belch. In people with GER, this muscle ring also relaxes at other times. Most people experience some amount of GER. When GER becomes excessive and results in complications it is called GERD.

Symptoms of GER vary and depend on a child's age.

It is not concerning for infants to have episodes of spitting up as long as:

• They are growing well
• There is no blood or bile (green material) in the vomit
• They are not having respiratory problems

Most infants outgrow GER by the age of 12 to 18 months; improvement may be noted when the infant starts to sit, stand or walk and when solid foods are begun at 6 months of age.

In older children, from toddler age to adolescents, symptoms of GER and GERD may include:

• Chest pain
• Heartburn
• Refusal to eat
• Sensation of food being stuck in the esophagus
• Sour taste at the back of the throat
• Vomiting

In older children, obesity can be a cause of GER/GERD.

Diagnosis of Gastroesophageal Reflux

If your older child experiences these symptoms, a pediatric gastroenterologist can perform a physical exam and additional tests to make a diagnosis, assess the severity of the problem and establish associated complications. Tests include:

• pH tests. A pH test can determine if stomach acid is traveling into the esophagus. Types of pH tests include:
  • Esophageal pH probe (uses sensors to detect acid reflux)
  • Bravo probe (uses a wireless capsule to monitor and measure acid reflux)
  • Impedance probe study (checks for acid and non-acid reflux)
• Upper gastrointestinal (UGI) fluoroscopy. This test will show the size and shape (known as the anatomy) of the upper gastrointestinal (GI) tract through X-ray images. It will allow the pediatric gastroenterologist to see if any obstruction or structural problems may be the cause of your child's symptoms.
• Nuclear medicine. A gastric emptying study (a type of nuclear medicine study) measures how fast the stomach empties food.
• Upper endoscopy. This test allows the pediatric gastroenterologist to examine the lining of the esophagus, stomach and duodenum (first part of small bowel) using a camera in a flexible tube called an endoscope. He or she will look for mucosal damage from GER or other causes leading to similar symptoms.